Dementia

By:
Pirzada m.muneeb
Definition of Dementia
 A significant chronic loss in memory and/or mental functions, involving
structural damage to the brain.
 Dementia may affect people differently, depending on the area of the brain
affected.
Types of dementia
 Alzheimer's disease
 Vascular dementia
 Lewy body dementia
 Fronto temporal dementia
 Huntington's disease
 Creutzfeld jacob disease
 HIV related dementia
Alzheimer's disease

Alzheimer’s disease is the most common form of dementia, accounting for between 50 and 70 per cent
of all cases.
Symptoms
Almost all brain functions are eventually affected, including
Memory
Movement
Language
Judgment
Behavior
Abstract thinking
Risk factors
The most important risk factors include age, family history, head trauma and Down syndrome.
Age onset
Most individuals with the disease are age 65 or older.
About 5% of people may develop symptoms before age 65.
At age 80 risk of Alzheimer's is 50%.
 Alzheimer's disease

Effects on brain
 Plaques and tangles
 Damages and kills brain cells
 Fewer connections among surviving cells
 Significant brain shrinkage
 Anatomic changes to amygdala,
Hippocampus, cortex and basal forebrain.
Vascular dementia (multi infarct)

Is the second most common cause of dementia accounting for 20% of the cases.
It is caused as a result of brain damage due to reduced or blocked blood flow in blood vessels due to damage from
cerebrovascular or cardiovascular problems (strokes).
Symptoms
Similar to AD, some functions might be intact others might be lost.
Hallucinations and delusions
Focal deficits
Gait disturbances, abnormal reflexes
Personality changes and loss of social skills
Risk factors
Increasing age
High blood pressure (hypertension)
A history of heart attack or strokes
High cholesterol
Atherosclerosis occurs when deposits of cholesterol or plaques build up in the arteries and narrow blood vessels, reducing
blood flow to the brain.
Diabetes High glucose levels can damage blood vessels throughout the body, including the brain.
Smoking directly damages the blood vessels that feed blood to the brain.
 Vascular dementia (multi infarct)

 Age onset
 Affects people between the ages of 60 to 75, and is more common in men than
women.
 Effect on brain
 Abnormal heart rhythms results in forming blood clots that leads to blockage of small
blood vessels that feed the brain.
 Ischemic changes in the brain.
 Deprives the brain cells of oxygen.
Treatment
 Controlling underlying conditions that affect the health of your heart and blood
vessels can sometimes slow the rate at which vascular dementia gets worse, and
may also sometimes prevent further decline.
Lewy body dementia

Lewy bodies is the third most common cause of dementia after Alzheimer's disease and vascular dementia,
accounting for 10 to 15 percent of cases.
 It is caused because of abnormal microscopic deposits called lewy bodies that damage brain cells over time.
 Alpha-synuclein protein, the chief component of Lewy bodies, is found widely in the brain.
Symptoms
Symptoms overlap with Alzheimer's disease but also include:
 Hunched posture, balance problems and rigid muscles
 Visual hallucinations
 Delusions
 Malfunctions of the autonomic nervous system
 Rapid eye movement (REM) sleep disorder
Risk factors
Although the cause of Lewy body dementia isn't clear, several factors appear to increase the risk of developing the
disease. They include:
 Age
 Being Male
 Family history
Lewy body dementia

 Age onset
 Between the ages of 50 and 85.
What causes dementia?

 Dementia occurs as a result of the death of brain cells or damage in parts

of the brain. Dementia may be due to other problems like:
 Lack of blood/oxygen supply to brain areas
 Head injury
 Pressure on the brain e.g. from a tumor
 Hydrocephalus (fluid build-up between the brain and the brain lining)
 Neurological disease e.g. Parkinson's disease, Creutzfeld Jacob disease
(CJD)
 Infection e.g. AIDS
 Vitamin deficiency
 A long period of excessive alcohol intake
Acetylcholine

 Acetylcholine is one of several neurotransmitters in the brain,

chemicals that nerve cells use to communicate with one another.
 Reduced levels of acetylcholine in the brain are believed to be
responsible for the impairment of cognitive function and the
behavioral disturbances that affect patients with Alzheimer's
disease.
 By blocking the enzyme that destroys acetylcholine, will result in
the increase of the concentration of acetylcholine in the brain.
Cholinesterase inhibitors

 Acetylcholinesterase inhibitors are first-line medications for

the treatment of mild to moderate Alzheimer disease, and
are associated with mild improvements in cognitive
function, behavior, and activities of daily living.
 Acetylcholinesterase inhibitors can slow the progression of
Alzheimer disease, no pharmacologic agents can reverse the
progression.
Cholinesterase inhibitors

Mechanism of action
 Cholinesterase inhibitors inhibit (block) the action of
acetylcholinesterase, the enzyme responsible for the
breakdown of acetylcholine.
 The administration of Cholinesterase inhibitors results in an
increase in the number of acetylcholine molecules that are
available to interact with the postsynaptic acetylcholine
receptors, which results in an increase in central nervous
system acetylcholine activity.
Cholinesterase inhibitors

 Currently, three Cholinesterase inhibitors are prescrib­­ed:

donepezil (Aricept), galantamine (Reminyl), and
rivastigmine (Exelon).

The main mech­anism of action for each of these agents is

inhibition of cholines­terase enzyme activity, this prevents the
breakdown of acetylcholine and lets it stay for longer in
synaptic cleft for communication.
Non-pharmacologic Interventions for Reducing Behavioral Disturbances in Alzheimer's Disease

 Provide the patient with a predictable routine (i.e., exercise, meals,

and bedtime should be routine and punctual).
 Provide a safe environment (i.e., no sharp-edged furniture, no
slippery floors or throw rugs, no obtrusive electric cords).
 Install grab bars by the toilet and in the shower.
 Use calendars, clocks, labels, and newspapers for orientation to
time.
 Reduce excess stimulation and outings to crowded places.
 Simplify all tasks; break complex tasks into steps and provide
instructions for each step.